Miss Conduct on suspected anorexia

You guys may have noticed that ol’ Aunt Fattie hasn’t been around lately. Luckily, we still have friend of the blog Miss Conduct, who is a professional advice columnist (unlike, say, me) and therefore doesn’t get to stop writing simply because she lacks the gumption to take on other people’s problems. Miss Conduct, who is thin, may nevertheless be the only advice columnist writing today who truly gets fat issues, from the perspective both of body image (understanding what people go through and why they might want to lose weight) and body autonomy (believing vocally that nobody else’s body is your business). For instance, here’s part of her answer to a woman asking about getting her family to stop criticizing her weight:

Nobody is owed an explanation of why you don’t like to have your body criticized, and anyone who would actually need an explanation of something so patently obvious wouldn’t be capable of understanding it anyway. Assert your boundaries, and do it consistently. You’ve been letting your family get away with bad habits for a long time — I say this not to blame you, but to let you know that you may have to draw the line in the sand more than once before everyone gets the point. And the line can be drawn something like this: “I realize you mean well, but I’ve decided that I don’t care to have people criticize my body anymore. So please don’t! If you’d like to tell me what you think of my new recipe for brisket/the election results/that new Stephen King novel I saw you reading, I’d love to hear it!” Particularly, you should use the phrase “my body” rather than “my appearance.” Without being touchy-feely, this will get across the extraordinarily personal kind of rudeness that your relatives are engaging in.

Right on! Did I mention she’s funny, too?

Today on her blog, Miss C. is taking comments on a letter she received about the opposite end of the spectrum. The questioner is concerned about the health of a fellow runner, who has noticed another regular runner on her route seemingly wasting away. The question: Given the appearance of an eating disorder, is it appropriate to ask if this woman, effectively a stranger, is okay?

As it happens, I asked a similar question of Sweet Machine and Kate a few months ago. Some of my dance classmates commented that my teacher had lost weight, and I knew she’d had cancer the year before; I wondered whether it was appropriate to say “how are you feeling.” Both SM and Kate agreed that it was fine to check in on the condition that I leave out the precipitating body concern — that is, that I say “how are you feeling,” not “people think you look thin, how are you feeling.” But in that case, the teacher had told me herself that she was a cancer survivor, and I was quite a bit closer to her than this woman seems to be to her running companion.

I’m inclined, strongly inclined, to say that it is always invasive and rude to bring up someone else’s body, even noticeable changes, in a discussion of their health (though, again, not necessarily rude to inquire about their health in response to noticeable body changes, if you can be polite and subtle about it). Of course, anorexia is a serious disease, and if this woman is anorexic she needs help. But the questioner has no idea if she is or not. She could be naturally thin, with a range that bottoms out at model proportions, and could be inching down to the lower end of that range because of her running. She could be on medication or have a different illness that makes her lose weight but doesn’t preclude exercise. She could be going through a breakup, not wanting to eat and distracting herself by running laps. She could have a parasite or chronic diarrhea. Okay, the last one’s not too likely, but the point is that if you wouldn’t be comfortable asking someone about their diarrhea, or their love life or their medications — and with most people, especially strangers, you shouldn’t be — then you cannot presume to ask about their bodies.

Anorexia is a mental illness that needs and deserves help. So is binge eating. But just as you can’t assume on sight that a fat person eats compulsively or in binge quantities, you cannot assume that a thin or even a rapidly thinning person doesn’t eat at all. If this runner is anorexic, I sincerely hope that someone close to her talks to her about it and gets her help. But it’s not the job or the place of a semi-stranger with no knowledge of her life except through body-based guesswork.

Disagree? Want to add perspective? Agree but have a terser, perfectly crystalline way of expressing it? Head over to Miss C.’s blog — she emailed us this morning and said that she’d love to have Shapelings’ opinions (she did not ask for all the above gushing, but tough). So far everyone seems to be saying basically what I’ve said above, and there’s no need for a Sanity Watchers warning — I’ll let you know if that changes, though if it does I expect her to be issuing personalized smackdowns.

97 thoughts on “Miss Conduct on suspected anorexia

  1. Spot on, IMHO. There’s a huge difference between being concerned with a stranger’s health in an urgent situation — if this woman were to pass out or turn gray in front of the letter writer — than in a chronic situation. In an urgent situation, obviously you wouldn’t want to let the fact that you’re a stranger stop you from helping; in (what appears to be) a chronic situation, presumably either the woman already knows what’s going on, or has people who know her better who are already playing the Concerned Friend role. It’s natural for the letter writer to be concerned — this woman has a tangential but continual presence in her life — but it really is not her place to step in.

    This is a good time to relink amandaw’s post about trying to “help” people with disabilities, I think.

  2. I just want to emphasize a point that has been made both in this post and Miss Conduct’s comments:
    The person already knows.
    I repeat, the person already knows.

    Whatever you’re going to say, They Already Know.

    I recently had a conversation with co-workers about weight/dieting, and it was actually stated (by someone who has never been fat), “Well, some fat people just don’t know how much they eat/how overweight they are.”
    The arrogance appalls me. If the woman is anorexic, she knows what she weighs. If the woman isn’t anorexic, she knows how much weight she’s lost.
    Just as fat people know how much they eat (and that they are considered “overweight,” this woman knows that she’s lost weight.

  3. This one is so hard.

    I used to see a woman frequently at my old gym who looked literally to be wasting away. She didn’t look “naturally thin”, she looked chronically, terribly ill. Every bone and tendon was visible in her limbs, and she didn’t appear to have an ounce of muscle or fat anywhere on her frame…she looked literlaly like skin and bones, and her hair showed signs of thinning…I just felt so much for her and wanted to help. She would exercise nonstop, I once was feeling ambitious and did 60 minutes on a cardio machine and another 45 minutes of weights, and while she was there before I got there, she was still there, pedaling furiously on her elliptical, after I had spent another 30 minutes showering and changing and leaving.

    But I agree. My heart went out to this woman, and I assumed, probably correctly, that she is terribly ill, but I knew every time I saw her that it was in no way my place to say anything. Sad situation, but spot on advice.

  4. On behalf of my naturally very thin friend, thank you for this post! (She has actually had ‘concerned’ acquaintances try to slip MEAT into her food! Think of what that could do, physically and emotionally, to a lifelong Hindu vegetarian…)

  5. In my non existent guidebook for life there will be a chapter on other people’s problems.

    This is how it will go.

    You are concerned about someone? Do you want to help? How nice and sensitive of you to notice someone else’s problem and want to take action. Before taking action, please evaluate the situation as follows:

    1. Are you this individuals doctor? If yes then please help them, otherwise continue reading..

    2. Are you this individual’s therapist? If yes then please help them, otherwise continue reading.

    3. Is this individual a child? (Under 15) If yes then please answer this question: Is this individual MY child?, If Yes then please help, if no, proceed.

    3. Is this an emergency? By an emergency I mean is this person at immediate risk of dying or being seriously injured. If yes then please help them, otherwise proceed.

    4. Has this person requested your assistance or advice?
    If yes, then please evaluate your own credentials in this matter, if they are not strong then please refer this individual to a doctor or therapist.

    If you answered No to all the questions above then repeat this to yourself:

    “Other people are not my responsibility.”

  6. Confusion comes in because we hear so much about heartless people looking the other way when faced with problems that really do need attention and assistance… the not-waving-I’m-drowning people desperately wanting someone to notice and care about their problems, the victims of abuse at home who fear that what’s happening to them is right and proper…

    “Not my responsibility” is a pretty distressing statement, if made as a general case.

    Shouldn’t there be some way of indicating “I see you, and I will try to help you if you want me to” without pushing your nose firmly into other people’s business?

    (In an ideal world, when we asked each other ‘How are you today?’ as we passed by, this might be an opening for those who NEED help to express it….)

  7. “Other people are not my responsibility.”

    I think I’d disagree with this, as a general rule.

    But anorexia isn’t the sort of thing one can diagnose just from looking at someone, so unless the person is a close friend (i.e., in the position where one could approach the other woman easily, or has more of a clue than ‘well, she looks thin’), probably best to back off.

  8. I think we have a couple meanings of “responsibility” going on — I don’t think Shinobi’s flowchart means “I can wash my hands of other people,” but “I am not in charge of making sure others live in a way I approve of.”

  9. I dunno. I’d put the bar quite a bit lower than ‘only assist close friends if they request your help and you are a doctor or therapist.’

  10. The scenarios Shinobi wrote about are the only circumstances under which I feel qualified or justified in addressing someone else’s mental and physical health, which is what I understood to be the subject. Helping someone put their bag in the overhead compartment or something is very different from asking them if they’re eating enough — or telling them they have sex with the wrong people, or that their clothes are too tight, or that they shouldn’t eat sugar, or any of the other effects of thinking that other people’s lives are fundamentally your business.

    Also, I presume you’re deliberately overstating and do know how flowcharts work, but that would be “if they request your help OR you’re a doctor or therapist.” Or it’s an emergency, etc.

  11. People who are in abusive situations don’t really want strangers telling them they’re in an abusive situation. They may want or need support and help and affirmation from their friends and loved ones. Not everyone wants or needs the same things. Except for actual emergencies – people bleeding or fainting or seizing in public – there’s no way to know what someone needs by looking at them.

    Concern from strangers is dicey at best and condescending at worst. I’d suggest to the runner that if she’s concerned, she build a relationship with the other woman. In the course of that relationship, she may find out why the other woman is losing weight. At the very least, she’ll be able to figure out if that’s a boundary her friend wants her to cross.

    If she’s not interested in building the relationship, we’re back to it not being her responsibility. It’s a tricky thing, responsibility towards others. I’m responsible for my daughter, but not for my husband or any other adult. That doesn’t mean I have no responsibility at all; I’m responsible to many people, starting with my family and moving on to my employers and my patients and a variety of organizations. That responsibility governs much of behavior, but not anyone else’.

  12. One of the things that fat-positive people know–really, really know–is that you can’t make a medical diagnosis of someone by looking at them.

    And yet it seems hard to take that step when thinking about people who are much thinner than the norm, or much more muscular than the norm (see the bodybuilders discussion).

    And one of the really good lessons of the twelve-step movement (and I am not a wholehearted, uncritical supporter of said movement) is that people need to want to change before change can happen.

    If you see someone who looks like they need help, ask them if they would like any help. And then listen to what they say. Obviously, if someone is unconscious, or in the path of an oncoming train, you can skip that step.

  13. I’m responsible for my daughter, but not for my husband or any other adult. That doesn’t mean I have no responsibility at all; I’m responsible to many people, starting with my family and moving on to my employers and my patients and a variety of organizations.

    This is a terrific way of making the distinction. One is responsible to others, in the sense that one should act like a mensch, but that doesn’t translate into being responsible for others.

  14. Helping someone put their bag in the overhead compartment or something is very different from asking them if they’re eating enough.

    Who mentioned overhead compartments? I was thinking more along the lines of things like interventions for addictions, or a college kid noticing her roommate’s slipping into depression and offering to accompany her friend to health services.

    I think I read it the right way. The last bullet point. Wait for them to ask your help. If you’re a doctor or therapist, help. If not, refer them to someone who can. I think it’s generally advisable to refer things to professionals, because they know what to do, but I also think it’s acceptable, if one is in a close enough position to have some clue (not the case here, obviously), to bring up one’s concerns absent an emergency or an explicit request for assistance.

  15. Except for actual emergencies – people bleeding or fainting or seizing in public – there’s no way to know what someone needs by looking at them.

    Right — so call help for those people! There’s a huge difference between medical emergencies and chronic medical conditions. If you’re not sure whether something is a medical emergency, ask if the person needs help and call 911 (or your local equivalent).

  16. Also, the weird thing is that I think I know the woman to whom this letter is referring. And she is not anorexic: she is training for a marathon and coping with a serious case of celiac disease.

  17. Also, the weird thing is that I think I know the woman to whom this letter is referring. And she is not anorexic: she is training for a marathon and coping with a serious case of celiac disease.

    Oh, I hope you said so over on Miss Conduct’s blog! That’s a perfect illustration of how you just don’t know, from looking at a stranger, what her health condition might be.

  18. And I hope she tells them in detail what celiac disease is like. Again, if you don’t know someone well enough to want to hear about the lining of their intestines, back off their bodies.

  19. So I’m the one who wrote to Miss Conduct with the first question about dealing with relatives (including parents) who think it’s perfectly their business to comment on my body. Her advice looks good, but I was wondering, does anyone else here want to add anything about how they’ve dealt with family members? Especially when the concern is always couched as “I’m worried about your health.”

  20. I think your advice in the situation is spot-on, and I think the one thing I would add to shinobi’s flowchart is that I do think there are many situations where a teacher of a child or even a young adult does have the right to express concern over a student’s mental health either to the student, to the parent, or to someone in the school who is more qualified in matters of mental health. Teachers aren’t close friends of students (mostly), but they do have the chance to observe them day-in, day-out, in rather close circumstances, and to notice changes in behavior or warning signs. I do NOT think a teacher should EVER say anything to a student about her or his body, at all; however, if a teacher has noticed a student rapidly dropping weight, I do think in some situations it would be acceptable to at least ask parents (carefully, taking into account what they know about the situation at hand) if they should have reason to be concerned about their student (phrasing it like that also makes it seem less like “I know your child better than you do,” which does sound obnoxious though in very rare instances is depressingly true).

    Full disclosure: I was very, very much assisted by a college professor who took interest (and at one point direct action relating to his concern) in my mental health freshman year, so my objectivity on this issue is somewhat compromised.

  21. Generally, just Yes to what Fillyjonk said about my comment.

    That is the procedure that I follow to make sure I am not being an interfering bitch. I often fail at this, but I am working on it.

  22. One of the things that fat-positive people know–really, really know–is that you can’t make a medical diagnosis of someone by looking at them.

    And so what if you could? When I was first dealing with PCOS I was acutely aware of every physical change, great and small. Knowing that other people were also aware just made it harder to leave the house and look people in the eye.

  23. I think it is important not to discount the strangers intentions.

    If this woman is anorexic, she is suffering. Perhaps no one has said anything to her, or expressed support or concern. Sometimes it takes just one person to help someone realize what’s going on…

    Hope everyone is having a happy and healthy holiday season!

  24. Especially when the concern is always couched as “I’m worried about your health.”

    You just have to keep repeating “Weight and health are not the same thing” over and over, until they either get it or get bored.

    I mean, a lot of this stuff is like training a puppy. You’re not really going to get through to them through the power of reason; you’re just going to get them to stop peeing the fuck all over the carpet of your self-esteem.

  25. I am in a similar situation. My close friend recently moved in with someone we knew from high school, who I hadn’t seen for 4 years. This person is obviously in the grips of severe anorexia (I know she is not naturally thin – I’ve known her since she was 13, she was always very voluptous and hated it, had a terrible body image). She looks like she is on the verge of dying (emaciated, skin problems, thinning hair on her head, lanugo), only eats 1 package of instant noodle soup per day, and I am extremely worried. I have no idea if she is getting help or if anyone else is aware of her problem, but I want to reach out to her in some way.. but can’t think of any way to do it! I’m really torn on this. I avoid commenting on people’s bodies (except to respond with positivity to their negativity) almost obsessively.. was thinking of writing a letter, but what to say? I don’t have any basis for being concerned except for her appearence.

  26. People who are in abusive situations don’t really want strangers telling them they’re in an abusive situation.

    Well, no. Butting into other people’s business and assuming you know best about it is completely stupid. I’m not suggesting that the right approach to seeing a man covered with bruises should be to walk up and say “Poor dear, does your boyfriend hit you?”

    What I’m wanting is a non-aggressive way to, if you do see a stranger covered with bruises, indicate that you’re willing to lend a hand if they need and want one. Maybe they *did* just fall down a flight of stairs – in which case, OW, and offering a hand with something might be useful?

    Probably just the simple “Everything okay?” and then, if they say yes, moving on….

  27. I disagree. When I was a teenager I was pretty close to being anorexic. I dropped 25 pounds from my 5’9”, 130 lb frame in a matter of months, I stopped menstruating, I was cranky with everybody around me, I had shortness of breath even when I wasn’t exercising, I came close to fainting many times, etc. While I knew that I had lost weight and I was thin, and could objectively realize that it was a problem, I still thought I needed to get thinner to be more attractive.

    My mom and dad tried to reason with me about my weight, but I didn’t pay any attention. Lots of other teenage girls told me how jealous they were that I was so thin, so I thought that I was on the right track (and should lose more).

    If it weren’t for a couple of boys who I thought were cute telling me that I was too thin, I might not have ever realized that I truly had a problem. After I realized that I was not becoming more attractive to the people that I wanted to attract, I was able to start eating more.

    While I may be an outlier, I do want to illustrate that its not always a bad thing to comment when you feel that someone may be hurting themselves.

  28. Huh. I agree with pretty much everything people are saying, and Verena articulated this perfectly on Miss Conduct’s post:

    “In bringing up the subject, you aren’t shedding light on anything the subject doesn’t already know about, you’re just bringing the shame front and and center, which will always backfire.”

    Particularly for this context (a stranger).

    But here’s where I’m getting hung up in the larger question of responding to suspected anorexia (apologies if this goes too far off-thread/the topic of addressing a stranger):

    When anorexia grabbed hold of me and wouldn’t let go for several years, what I got was praise for killing myself. Constantly. From all over. Or silence. And it made my grief, isolation, and rage worse. When the very occasional person said something as simple as: ‘Whoa, you’ve lost a lot of weight since I saw you last – are you okay?’ it was a life-preserver, because it felt based in loving concern, and like acknowledgment of the obvious which other people either apparently couldn’t see or thought was hot. Like: I’m walking down the street on fire and not even the people who say they love me seem to notice, never mind offer a bucket of water.

    I’ve seen this tension for other shrinking women, too, in many contexts – silence is bad, controlling invasive judgment is bad, praise is worst. But gentle non-shaming concern based in some kind of ‘I can see you are suffering, your pain is visible to me, I love you, and I want to know how I can help’ has proven good, because the invisibility thing is often so intertwined with the shrinking.

    So, I’m curious what other people think about this. Obviously, I’m talking about a situation where the statement is coming in the context of relationship. And in general, I am an absolute believer in not inserting invasive judgment, inappropriate discussion of other people’s bodies, uninformed medical opinion based on appearance and no knowledge, etc.. But I wonder if anorexia doesn’t have particular dynamics – for some people anyway, of course there’s no monolithic experience – that make seeing what’s happening and saying so (carefully) potentially more useful.

  29. ’m inclined, strongly inclined, to say that it is always invasive and rude to bring u

    I suppose I’m just being picky, but maybe I’m being thoughtful, or trying to figure this out.

    It is perfectly okay socially, I think, to remark on someone’s skin tone. “You seem pale,” or “You’ve broken out in spots” are not considered rude. Even “You seem tired” is not considered rude, and that’s patently a remark upon the condition of someone’s face.

    What’s rude has to do with expectations about bodies, especially female bodies and expectations about what’s normative. It’s rude to remark on size or shape. Fat and thin are rude to remark on. It’s rude to remark on bodies that aren’t normative, to talk about kinky hair or dark skin or height, because all of those hover around bigotry.

    So exploring the meaning of “rude” seems like an interesting place to go.

  30. Theriomorph, that’s a good point — does our opinion of unsolicited concern change given the fact that a woman who’s losing startling amounts of weight is probably getting unsolicited praise from other quarters?

  31. Bonnie, I think that an old friend (even if you haven’t been close lately) is a different situation… and you see her not eating enough, which means you’re not guessing about a stranger’s health based on her body. I would say you were justified in saying “listen, a cup of noodle soup isn’t really a lot of nutrition” and going from there, rather than from what her body looks like.

  32. It is perfectly okay socially, I think, to remark on someone’s skin tone. “You seem pale,” or “You’ve broken out in spots” are not considered rude.

    Whoa. I think both those things are incredibly rude. Again, does it help anyone to be told how ugly they are?

  33. It is perfectly okay socially, I think, to remark on someone’s skin tone. “You seem pale,” or “You’ve broken out in spots” are not considered rude. Even “You seem tired” is not considered rude, and that’s patently a remark upon the condition of someone’s face.

    Yeah, I agree with Sniper — those things all seem rude to me, especially the one about breaking out. After all, having a certain complexion and being perky *are* normative expectations for women.

    I had a great dermatologist a few years back, and my skin cleared up fairly drastically over about three months. People at work (mostly women friends) started saying things to me like “Your skin has really cleared up!” and “Your complexion is really improving!” Like comments about losing weight, all this made me think was how glaringly ugly they must have thought I was before. (I think more clearly about it now!)

  34. See, I think both of those comments seem rude but I don’t see them as commentary on how ugly a person is. Pale /= ugly. Spots /= ugly (though they may indicate an allergic reaction that needs immediate treatment. Like, spots have value that is not aesthetic.

  35. JupiterPluvius, I’ve been diagnosed with coeliac disease for four years now, and when I was at my worst (right before diagnosis), I could barely get out of bed, let alone run! I really hope your friend can keep up her training while dealing with her illness. There are more and more resources out there now and I do hope she is making use of them. Best of luck to her!

    As to the general topic up for discussion, I wanted to point out as someone who was anorexic for many years, if someone asked me what was wrong, I would say NOTHING. A major factor of this mental illness is that you hide it. For me, nothing was wrong. I was getting THIN and I felt on top of the world! I completely denied having any problem whatsoever (other than being ‘fat’) and had to be forced into treatment.

    So, for me, unless we’re talking about someone who is a minor, family member, patient, or extremely close friend who has discussed such a topic with me previously, I would bite my tongue, no matter how difficult that might be.

  36. does our opinion of unsolicited concern change given the fact that a woman who’s losing startling amounts of weight is probably getting unsolicited praise from other quarters?

    I know that when I was undergoing the Great Shrinkening last year, I actually really did appreciate it when people said things like, “You look like you’ve lost weight — was it intentional? Is everything okay?” because it did balance out all the praise I was getting. But again, these were people I already knew, and they got an earful about my intestines in return.

  37. Sweet Machine, I didn’t read breaking out in spots as being commentary on acne – more an extreme example of someone having an ill health moment. But spots IS slang for acne so maybe I’m wrong.

    Ultimately, I think “You look pale” is meant in this example not as a remark upon complexion but on a “are you about to pass out” level.

    At which point the trick becomes knowing how the person being questioned is going to interpret the question. Which you can’t always know when the person riding the bus with you looks like they’ve just greyed out and is about to keel over.

  38. Ha! Cross post!

    Okay, I was not reading Deborah’s examples as being in a maybe-emergency situation. Yes, if someone goes ashen, saying something (followed by “Can I help?”) is a good idea. But just blithely saying “Hey, you look pale!” in a nonmedical context seems rude to me.

  39. Cross-posting for the win!

    Yeah, that’s why I said it seems rude to me, too – it’s one of those days so I feel like I’m not making much sense at the moment but taken out of context, “You look pale” really does seem like a rude and unnecessary statement. Then, about halfway through my first comment, I was like, “hey, what about sudden changes in state indicated by physical markers like ashen skin and rash?”

    I’d still be way more inclined, especially with a stranger, to ask if they felt okay instead of phrasing my concern as commentary on their appearance. Or at least I’d try to be specific. “You suddenly look uncomfortable.” etc., etc..

  40. I really wish that people would know better than to remark on a stranger’s body. When I broke a bone in my finger last month, I got all kinds of strangers stopping me in the street to ask me about it — even to the point of asking, “Did you get in a fight with your boyfriend?”

    Well, the thing is — every time I got asked about it, I relived how it happened, and how anxious I was about what was going to happen next. Which led to my yelling in the middle of Union Square, “I HAVE A TUMOR IN MY BONE!”

    I still don’t think this is an overreaction. My body belongs to me.

  41. Ok, so, we’ve covered distinctions between friends, family members, patients, strangers, etc. in terms of when it’s ok to say something.

    Here’s a similar question, and I hope someone has some insight.

    I’ve worked in several athletic facilities (and just got hired at another one today). I am not a doctor. Nor am I a certified trainer. I’ve been certified in lifeguarding, CPR, and first aid at various points (but currently am not). I am a person with a lot of experience, who teaches and helps other people use equipment — free weights, resistance machines, cardio machines, rock wall, paddling boats, et cetera, and in one position, I helped plan basic exercise routines. If I’m working somewhere, and week after week I see someone come into the gym, and can see that they are exercising a lot and starting to get rather thin, would I be out of line saying something?

    On one hand, I only know them in the context of the gym, and I’m not a professional anything.

    On the other, I am responsible for health and safety at the gym — correct use of equipment, responding to accidents and emergencies, stuff like that. If someone passed out or started to bleed, it would be my problem. If someone is doing an exercise wrong and may hurt themselves, it is my responsibility to correct them. A big part of safety at the gym is prevention, too. So, do I have to wait for a person who is starving and overworking themselves to collapse in my gym before I can say anything?

    Thoughts?

  42. Don’t forget if you really worried you can slip them a business card with hotlines or even wesite
    without them knowing who it was

    Sarah, I don’t think if would be wrong to put a card with an ED hotline or website in her locker

    then the choice to get help is still theirs

  43. THIS.

    “anyone who would actually need an explanation of something so patently obvious wouldn’t be capable of understanding it anyway”

    As a tattoo. Inside my eyelids.

  44. I’m not sure anyone would advocate ignoring strangers as they, say, went into anaphylactic shock, clawed at their throat for breath, passed out, and died.

    Personally, I think it’s an individual, case-based choice. I try to avoid commenting on people’s appearance – pregnancy, age, hair loss, pallor, glassy eyes – the whole nine yards. But I think it is okay to check in with someone who is looking more and more ill. I think I’d gather my courage, try to strike up a conversation (how hard can it be – there’s all that running masochism to bond over), and get to the point where you can say casually, “Hey, how *are* you?” Not “I brought you cookies because you look so thin” or “My God, are you dying?” or “So, there’s a betting pool about whether you’re anorectic or have celiac’s.” Make friends (or acquaintances), or butt out.

  45. When anorexia grabbed hold of me and wouldn’t let go for several years, what I got was praise for killing myself. Constantly. From all over. Or silence. And it made my grief, isolation, and rage worse.

    I know just what you mean. At my worst, the praise…the praise was everywhere. Every time I saw my aunt, my cousins…it was all praise and encouragement to keep up the good work. Because I was sick, I used their comments as proof that I needed to keep going, but I was constantly aware of the sheer nutiness of the situation. If they knew I was exercising until I cried and seeing if I could make it through the day on a grapefruit and a bowl of soup would they still have encouraged me to keep up the good work? Since I stopped engaging in disordered behavior, I’ve gained weight and they never say a positive or negative word to me about my appearance now. And while I’m glad not to have to hear comments on my appearance, knowing that they were once overflowing about how nice I looked, how great my hair looked, etc, etc… it kind of burns to know I was only worthy of complimenting when I was slowly killing myself.

    In response to the original post though…I think it’s near impossible to address a problem like anorexia with a stranger or casual aquaintance, but I can see the temptation. Unfortunately, it’s almost too hard to address it even with people you love. My former best friend was anorexic and bulimic and talking to her about it was plainly torture. She would try to get me to agree with her about how good she was by not eating or she would tell me that she had thrown up, but then tell me it wasn’t a big deal. But if I said I was concerned, she told me that she didn’t have a problem and that I should go suck eggs. Even when she had health problems that seemed to be tied to her illness, she withheld that information from the doctors. And if I suggested speaking to a counselor, even if just to deal with her extreme body hatred, which she expressed daily? It would get ugly.

    Because she didn’t want to stop and she didn’t want help. And since she was legally an adult, there wasn’t much I could do about it. It didn’t stop me from trying, from asking, but she didn’t try to stop that either. Maybe she liked knowing there was a lifeline there if she wanted it, I don’t know, but the whole situation reaffirmed for me that you can’t make choices for other people, even if they are definitely making the wrong ones. All you can do is let them know that you’ll be there for them.

  46. IMO, real and true concern for the feelings, health and wellbeing of another human is never rude and never out of place.

    You need to be SURE that you’re not feeling secretly superior, silently smug, or being the “how you should live” police AND that you have a genuine concern. A very dear friend calls this the three doors before you speak – Is it True? Is It Necessary? Am I being Kind? If you can honestly answer “yes” to all three, voice your concern politely, respectfully, and without blame of the other person. And then you should either be ready to accept that you’re unsolicited concern may be resented and apologize profusely, or ready to offer help.

    In the Miss Conduct example “Hi Jane, how are you feeling today?” with eye contact and an earnest attitude is not rude, and pretty much all that’s called for. There is no need to comment on “Jane’s” appearance or running habits in the least – unless she faints or something.

    As a second point, many mental illnesses – anorexia and eating disorders among them – carry with them a symptom called anosognosia, which is the inability to recognize that one is actually sick. The parts of the brain that are responsible for this kind of self-awareness are often impaired with mental illness, and the sufferer is literally unable to recognize that they are experiencing disease. It also happens to some stroke patients. So unfortunately, not only may a sufferer not know, they may also think it’s everyone ELSE who has the problem.

  47. All you can do is let them know that you’ll be there for them.

    Yeah. This is such a painful situation, Jae, when someone is dying but can’t accept/doesn’t want help. I do think it matters to know, though, that someone sees what is happening and cares.

    rowmyboat, my .02 is that from the sounds of it, I do think that as staff who helps people train you’re in a position of responsibility for safety & it might well be appropriate for you to (kindly & respectfully of course) say what you see and try to help develop a safer approach. Or to speak to a trainer about your concern. You’re not a stranger accosting another stranger about how they look – you’re gym staff responsible for co-creating a safe athletic environment with the help of the clients and the other staff, and you can create a relational context pretty quickly because of that.

    If for some reason that doesn’t feel right, here’s one other thought: I think more general awareness campaigns in gyms/dojos/whatever where women train are really good – ED/compulsive exercise are a real thing, and body shame in general can stop women from training at all – trainers, class instructors, and gym staff will sometimes be in the best position to see these things and offer support. Even something as simple as a perky sign at the desk saying ‘Body positive zone! Love the body you’re in while safely building the fitness you want!” can create an ethos – and an opening for further discussion if a client wants it and/or if a trainer or staff person has safety concerns.

    Obviously, the gym and/or the trainers would have to be on board. Sadly, they often aren’t.

    It goes back to the original post – anorexia and bulimia and compulsive exercise do exist (and often co-exist), they are extremely dangerous, and they will be most visible in gyms, dojos, on running trails, etc.. . .and of course we can’t run about shouting at strangers thinking it’s ever going to be useful or appropriate.

    But if a woman is wasting away and we’re not strangers, if there is any kind of relational context to support it, I feel it’s worth some thought about how to say we see what’s happening, we’re concerned, we’re available for help or support, and we’d like to help if we can.

    The most helpful people in my life expressed concern and care, offered help if I wanted it, stayed close but didn’t bug me all the time, and NEVER made it about THEM (the other thing that always happens, it seems).

  48. — cross posting this on Miss Conduct & Shapely Prose —

    I think the appropriate response really depends on the relationship. If my mom, brother, or close friend was looking ill and thin, I would be blunt – “It looks like you’re not eating enough. Are you okay?” And if the response was “I’m fine,” I’d keep pushing.

    If a non-close friend or classmate who I’m on good terms with looked ill and/or too thin, I might say, “Hey, you’re looking a little drawn/tired – are you doing okay these days?” If the response was “I’m fine,” I might just leave it at that, or I might say, “okay. I’m always around to talk if you want” – and then not bring it up again.

    If it was a casual acquaintance, I wouldn’t say anything unless I was quite worried. And, my first response would be to check in with a mutual friend if possible – like, “Hey, I know you’re friends with Jane – do you know if she’s doing okay?” If there wasn’t a mutual friend, I might go to Jane and say something along the lines of, “hey, I know we’re not close, but you look like you’re having a hard time these days. [I might add something about my own ED, if appropriate]. If you ever want to talk about it or anything, I’m around. ” And then I wouldn’t bring it up again.
    and if I didn’t know the person at all –

    And if I didn’t know the person at ALL – we’d never spoken – I wouldn’t say anything. There used to be a woman at the gym I went to who looked dangerously, painfully thin. I’m 100% she wasn’t healthy, though of course I don’t know if it was anorexia, chemo, or something else. But, I saw her with various trainers regularly, and while I was surprised that they let her exercise at all – she was SEVERELY underweight/emaciated – the gym staff saw her. It might have been their place to comment, but it certainly wasn’t mine.

    (and rowmyboat – in your situation, i’d bring the situation to your supervisor. i don’t think it’s necessarily your position to confront the person, but i would think most gyms do occasionally encounter this kind of situation & might have some kind of protocol, or at least there might be someone with the authority to speak with her – perhaps a sports doc or something)

  49. I agree that it is usually okay to comment on a stranger’s appearance/ health status or even the appearance/ health status of an acquaintance if you don’t have additional information – with the exception of situations when one is not sure if the other person needs immediate help.

    However, I think it is different for friends or other people you know well (such as students, close family members etc). I think the most vital point here is information – if you know what a person is eating in addition to knowing that the person has lost a lot of weight it is okay to comment. But it is important to be truly willing to listen and it is important how the comment is framed.

    For example, I have had atopic dermatitis pretty much all my life, and sometimes quite badly. In middle school a teacher literally said to me, “This is getting really bad, you almost look like a streusel cake”. This is a completely unacceptable comment, no matter what the intention was. (It was made worse by the fact that she said it in front of other students who were calling me names because of my skin condition anyways.)

    However, I have also had people comment on my skin condition in ways that I appreciated. These comments are usually comments of true concern. (Personally I find it kind if someone asks me if the excema hurts – it gives me freedom to talk about the fact that it does hurt if it is really bad, something I would never mention otherwise. I just don’t want people to dwell on it.) Another form of comment that I appreciate is if people ask me in a neutral but curious way about my skin condition – in college I actually had a fellow student who asked me and at the same time touched my hand (she was from another culture – you usually don’t touch others a lot in Germany). I guess a lot of people would have found it intrusive, but since she was clearly genuinely and non-judgmentally curious and because people had previously expressed disgust at the thought of touching my hands because of my skin condition this was actually a positive gesture for me.

  50. This is in response to Caro who wrote the original post to Miss Conduct about family members who are the original concern trolls. My mother is a physician who used to think that it was her right and perhaps even her responsibility to comment (in the guise of “concern for my health”) about my weight and also to ask questions about some health problems I have. I solved the problem in two ways, neither was easy but eventually they worked. I told my mother very forcefully but at a conversational level that my weight was absolutely off limits. I told her I was an adult and I didn’t ask her about such things (my mother is also fat) and she was NEVER to bring up the topic again. When she did, I said “I told you my weight was off limits. Next topic please.” When she was perpetually asking me if I was doing my follow up visits etc after I had cancer (I’ve had endometrial cancer x2, I’m clear at the moment), I told her that she was not my doctor (she’s a psychiatrist, not an oncologist). I told her I had very good doctors who took care of me and it was none of her business. She did the “but I’m your mother” routine. I told her that I was an adult and I would handle it. It drove her batshit (she’s a control freak, story for another time) but she stopped getting in my face about it. My mother does not live locally and I have caller ID so I can avoid her if I need to. I also no longer modify what I eat in front of her and I make sure to tell her when her comments on what I am eating are inappropriate. It’s taken a long time to get to this point and it has completely changed my relationship with my mother. But it was a relationship that had to change in order for me to be comfortable with who I am.

  51. It was made worse by the fact that she said it in front of other students who were calling me names because of my skin condition anyways.

    That is just dreadful. Ugh.

    My “favorite” comment was the not-quite-stranger who looked at my (lack of) hair and called out, “Do you have some kind of disease?” in a room full of people.

  52. Bean,
    Thanks. So it sounds like the Miss Conduct approach (which it seems like you were applying) works when you do it forcefully. I have tried rather timidly with my parents, with mixed success. But I don’t think I’ll ever be comfortable eating uninhibitedly in front of them. My mom’s not as bad, but my dad’s gotten truly awful. He had a cardiac bypass recently. He was thin, healthy, and exercised a lot, with no health conditions/risk factors that we knew of. It was basically completely genetic. But rather than take the message that hey, you can only control so much about your body and its destiny, instead, he’s gotten even worse about making nasty comments about food and weight. And it’s all in the name of “I don’t want you to suffer like I have.” I’ve been giving him somewhat of a free pass since the surgery was just 3 months ago, but now that he’s more or less back to normal physically, I guess it’s time for me to start asserting some boundaries.

  53. … put a card with an ED hotline or website in her locker …

    Erm. It may just be me — I know I’m a bit paranoid — but IMHO? This gives off a seriously creepy vibe. Like, live-action concern stalking, and if it happened to me, I’d wig out.

  54. … put a card with an ED hotline or website in her locker …

    Yeah – I’m with you, Eucritta.

    Is there any woman on the face of the planet who has managed to avoid knowing what eating disorders are about and is completely free of body image issues?

    This just seems like something one does to make themselves feel better for having done something, but does nothing to actually help.

  55. At the risk of having tomatoes thrown at me I’m going to disagree with the party line here. Someone with anorexia may or may not know s/he is ill; a classic symptom of the disease is anosognosia, the inability to know that you’re ill. Our national obsession with thinness makes it actually very hard to notice when someone is way too thin, so chances are good that by the time you do notice, that person is far beyond “naturally thin.”

    I’ve spoken to strangers. I doubt it’s very effective, as others have pointed out. More effectively, I’ve spoken to friends/family of people I don’t know very well. The look of someone with anorexia is fairly easy to identify once you’re familiar with it. I once pulled aside a mother I had never met to tell her that her babysitter looked very ill to me. That was the comment, it turned out, that got that young woman help. Many people had been thinking she looked ill but no one wanted to say anything.

    I’d rather speak up and run the risk of being thought rude than shut up and let someone go on suffering.

    After my daughter was in treatment for anorexia, at least a dozen acquaintances said, “I knew she had anorexia.” To which I replied, “Then why the hell didn’t you say anything?”

    My two cents.

  56. I think I agree with Harriet here. I don’t have any experience with eating disorders in particular, but … I mean, I spent most of my teenage years wishing I’d freaking faint in public already. I didn’t have anyone to ask for help, so unexpected help from a stranger would have been the best thing to ever happen to me. Sure, I survived … but now I’m sitting here with tears in my eyes just from being reminded of that time.

    You talk about family members, close friends, teachers and doctors as if it was a given that those will actually have a clue what’s going on. It is entirely possible that you, the complete stranger, are the only person who knows how to help.

  57. JP’s and Harriet’s and Tiana’s comments raise an interesting question: Do different rules apply here when we are talking about a child or teenager as opposed to another adult? I think they might. Kids often need guidance from adults and are loath to ask for it when the problem is “embarrassing.”

    And Harriet, I note that you actually raised the issue with another adult rather than approaching the child or teenager directly. That’s a lot different from butting into an adult stranger’s private business.

    Of course, being aspie AND employed in health care, I’m perfectly okay with hearing about a total stranger’s colon lining issues, so I have to pick different buttinsky criteria. I think if I knew them at all, I’d ask them if they were feeling okay, but if I didn’t I’d probably get a brush-off answer anyway, so my choice would be either to try to get to know them better, or forget about it.

  58. “I’d rather speak up and run the risk of being thought rude than shut up and let someone go on suffering.”

    Yes x 100.

    “put a card with an ED hotline or website in her locker ”

    People with eating disorders already don’t feel safe in their own skin, and this will only exacerbate that feeling a million times over–rather than help her, it’s far likelier to drive self-panicking, hamster-wheel thoughts (“Who’s watching me? Who’s noticing me, who’s looking at my body, who put this in my locker?”) and shove her deeper into denial.

  59. Miss Conduct might get fat issues, but I’m really hoping that she one day sees her way clear to retracting her “ew, gross” bullshit about breastmilk being “seriously inappropriate” in an office refrigerator.

    Till then… yeah, the sight of her column just pisses me off. Sorry, fj. Not a fan.

  60. I used to work in retail, in the clothing department of a big box store. There was a woman who used to shop in my store who was most likely anorexic. She was visibly skeletal. We were all worried about her.

    We decided that the best help we could give her was to be polite and friendly and treat her like any other customer, because if she was anorexic, surely treating her differently would only reinforce how terrible she thought she looked and make her all the more determined to continue losing weight; and if she wasn’t, treating her differently because of how she looked would still be monumentally rude and to top it off morally wrong. So every time she came in we would greet her like any customer, ask her how she was today, if there was anything we could help her with, just pick up the red phone if you need me, gee that’s a great color on you and are you finding the long jeans okay? (This woman was really super tall.) We made positive, helpful comments about the clothing she chose to try on, just like with everyone else, because it was our philosophy that if you felt good about your body while shopping with us, you’d want to continue shopping there.

    Eventually one of my coworkers struck up a reasonably close friendship with this woman. It turned out she had been anorexic but was in recovery, and if we had asked her something so terribly rude and invasive as was she all right, was she eating okay, it might have set her back.

  61. Hi, longtime lurker here, first time poster. I felt compelled to post a comment after reading this post.

    It’s been interesting to me to read the comments here of those who have suffered with anorexia – everyone has a different experience. Ten years ago I became extremely sick with anorexia and bulimia. I think if someone had approached me in the initial stages of my disease, I would have assumed they were the ones with the problem. After I went into treatment and was “out,” so to speak, people felt like they had the right to comment on my appearance. The sad thing was, every time someone told me I was too thin or looked sick, I pitied them. I thought, “Poor so-and-so, he/she’s delusional, and obviously doesn’t know what a thin person looks like.” If they said they were concerned for my health, it was in one ear and out the other. I was positive I wasn’t sick enough to have health problems. This is a common thread in eating disorders just based on the people I’ve known.

    Sadly, there have been times when my weight was considered normal and everyone assumed I was fixed. It doesn’t bother me so much now, but remember you can’t evaluate the seriousness of an eating disorder simply based on weight. Someone might be extremely thin and in recovery; another might be normal or overweight and still struggle terribly.

    Lastly, just because someone looks underweight, you can no more assume that they have an eating disorder than someone who is overweight. You wouldn’t go up to a fat person and tell them about OA and how they could get help for their compulsive overeating – because you can’t determine, from someone’s body size, what or how much they eat.

  62. I’ve spoken to strangers. I doubt it’s very effective, as others have pointed out. More effectively, I’ve spoken to friends/family of people I don’t know very well. The look of someone with anorexia is fairly easy to identify once you’re familiar with it.

    Harriet – The look of someone with anorexia might be easy to identify for you, but for many people, including doctors, it just isn’t. I have a naturally very thin friend who has been asked many times in her life if she is anorexic by concerned strangers or acquaintances that don’t know her that well. The last time she was asked about it (or in this case questioned about it for quite some time the way she described it) was by a doctor.

    Concerning the doctor I was kind of torn because I know how many doctors don’t inquire if a person has an eating disorder, and how much harm could be avoided if they were more vigilant (and I told my friend so). Nonetheless these questions are very difficult for her because she has been teased because of being underweight in her childhood to the degree that she was afraid changing before gym lessons. (The kids called her “spiderhands” or “skeleton” and commented on how gross she looked.)

    Now, as I said before, I think it is okay to speak out if one has some behavioral information in addition to a person’s body weight, and even if someone loses a lot of weight very quickly it might be okay to ask that person how he or she is doing. But as long as one has no indication why a person is very thin I find commenting problematic.

  63. Damn, lauredhel, that breastmilk thing was her? I hadn’t connected it. That was hurtful. I’m disappointed.

    Reading what people have to say It’s just clearer by the minute that I’m always relieved when there is a clear, relational opening to talk about it with someone I think may be active with anorexia – because when there isn’t, it’s really hard for me to know how, if, when, why to approach it.

    Any time I feel like I have a shot at getting heard, I will always say some small thing towards health and food and self-care, but I don’t always have an appropriate context for a deeper conversation. Maybe the thing we can always do is that former general support, and if we have a relationship with someone (or can build one) we can get into direct conversation about ED.

    One thing I’m feeling, though: I think getting paralyzed with fear about how we – the person expressing care and concern – will be the thing that breaks an anorexic, or pushes her off some kind of edge, feels potentially patronizing and unlikely to me.

    As slythwolf was saying about their approach in the clothing store, I think treating any woman in any condition – good bad or indifferent – as if she is strong, resilient, multifaceted, and in charge of her own life is essential, because she IS.

    She may also be sick and need support, she may even be in extreme danger – but if she’s up and walking around, she deserves to be treated as someone who is still living a whole life of which anorexia is a part. She isn’t a mental illness walking around on two feet, she’s a woman who is responding to her life – sometimes very well, probably. In some areas, not well at all. Like any of us.

    So my thing is always to not reduce a person to a symptom, even when that symptom scares the crap out of me or hits my own buttons from having had ED, but instead to speak to her strength.

    It helps that many, some say most, anorexics are perfectionist high performers who have a lot of positives in their lives – they might not always see them (who among us does when we’re hurting), but we can notice them and not communicate to someone that they are nothing but their body, nothing but their self-hate, nothing but dysfunction – that in fact, there are measurable, real things in their life proving that they are strong, smart, talented, good at their job, kind to others, whatever.

    Anorexia’s a serious, scary thing, yes. And there’s a lot of disagreement about what it is and how it functions and how it’s triggered – addiction camps, genetic camps, environmental camps, media images and sexism camps, check D for all o’ the above though probably slightly different for each person camps (which is where I fall). Who among us is completely free of self-destructive behaviors, regardless of their origins? If we approach someone to give ‘help’ with sanctimony, we’re history (with good reason). If we approach them with patronizing (you’re so sick and broken, honey, you can’t be trusted to help yourself), same thing. Also? Both of these are plain wrong and ineffective. We’re not better than they are, they’re not nothing but their illness, and it’s a guaranteed to fail approach.

    If we express genuine care and desire to help, even if we’re clumsy about it, even if someone is defensive and defended, I believe that gets across on some level. I’m such a huge fan of saying what I’m worried about and using the phrase ‘how can I help?’ rather than offering what *I* think is right before I’ve bothered to listen. Even if the answer is ‘I don’t know’ or ‘I don’t need help’ it gives a chance to the interaction, to both people, to establish trust and relationship and try again later (or better, or a little at a time over time).

    I don’t think kids are the only ones we should approach, I do think *how* and *when* and *why* we approach anyone should be carefully examined.

    It is entirely possible that you, the complete stranger, are the only person who knows how to help.

    What Tiana said made me cry because it’s utterly true – and also because you might also be the only one who is *willing* to help. It’s quite possible every single person in an active anorexic’s life actively supports her illness.

  64. Well put, Theriomorph. And yes, I do see a difference between approaching an adult on behalf of a child (or young adult), and approaching, say, a middle-aged woman. Adults who have been chronically ill for a long time have no doubt been in treatment on and off for years. Recovery is very difficult once the disease is chronic. But kids, teens, and people in their 20s still have a lot of hope for recovery, and, ideally, someone or someones who can help them get there. I personally think it’s nearly impossible to recover on your own because of the nature of the disease (I’m talkiing anorexia here; bulimia is different). So you need help–not just someone to point it out to you, cause that’s probably not helpful, but someone to guide and possibly take charge of your health until you can manage it again.

    I was shopping with my 13 year old once when we met another mom and daughter also shopping. The girl, who looked the same age as my daughter, was saying things like “I won’t wear a size 12! That’s gross. I want to wear a size 6x.” I said something as tactful as I could to the mom, who looked at me like I was the devil incarnate and nearly ran away. But I dunno, maybe she remembered what I said later on when it could be helpful and she could hear it.

    As far as recognizing the look of someone with anorexia, you’re right; it’s more than thinness. It’s also a look of deep despair and hopelessness in their eyes. You can cover it up sometimes but it’s under there. It’s a look that haunts my dreams.

  65. Harriet, I’m not going to throw tomatoes at you, but I do think this statement is very problematic:

    The look of someone with anorexia is fairly easy to identify once you’re familiar with it.

    This may be true for you; you have personal experience with it and have done a lot of research in it. But for most people (including, I imagine, the letter writer here), “the look of someone with anorexia” = “what I think is too skinny.” Women’s bodies are already treated by default as public property, and inviting strangers to comment on them, even in the guise of reaching out to help, strikes me as antithetical to body autonomy and treating women as adults.

    I understand that phenomenon of suddenly seeing evidence of a disease around you, sixth sense style — my mom has Parkinson’s and when I pass elderly people on the street now, I look for the distinctive hunched posture and rapid steps that are common signs of the disease. IIRC, Joan Didion describes something like this in The Year of Magical Thinking about grief — she suddenly was struck by how it was as though she could see other people who were grieving by (as you say) the look in their eyes.

    But in my opinion, even if you find yourself with this somewhat unenviable skill of feeling like you can identify disease by looking, it is still not your place to comment on a stranger’s body and health unless it is an emergency. You think you know what’s going on, but you are seeing that person for one minute (or 5, or 10) out of the 24/7 existence they live. You don’t know what’s going on — you don’t know if they’re in treatment, you don’t know if they’re having a good or bad day, you don’t know if they’re on the verge of a setback, and, most importantly, you don’t know if you’re right. I admire your compassion and I do think it’s a different call with minors, but I respectfully disagree about the original scenario here.

  66. I understand that phenomenon of suddenly seeing evidence of a disease around you, sixth sense style — my mom has Parkinson’s and when I pass elderly people on the street now, I look for the distinctive hunched posture and rapid steps that are common signs of the disease.

    Oh, heavens, yes. Parkinson’s is very commonly diagnosed visually by neurologists. My dad’s neurologist literally diagnosed him by seeing him walk into his office (then he did a bunch of tests, of course, but he said the first impression was overwhelming).

    Like you, I find that I have an internal sense of what Parkinson’s symptoms look like now, after the past 8-10 years with my dad’s active phase of the illness.

    Harriet, I do take your point that someone who has themselves experienced anorexia, or who has been a caregiver for someone with anorexia, are attuned to visual cues that make it possible to distinguish the person with anorexia from the person who is either naturally very thin or has lost an unusual amount of weight from some other circumstances or illness.

    But the person who wrote to Miss Conduct didn’t seem to have that experience. As she phrased it in her letter, at least, the thing that made her think the woman had an eating and/or exercise disorder was a) that she was thinner than she had been, and b) that she was running more.

  67. Miss Conduct might get fat issues, but I’m really hoping that she one day sees her way clear to retracting her “ew, gross” bullshit about breastmilk being “seriously inappropriate” in an office refrigerator.

    Lauredhel, I can’t find a link because the Boston.com search function sucks, but I’m about 95% certain she did, in fact, write a follow-up column or blog post in which she addressed the many objections to that column. IIRC, she acknowledged that “seriously inappropriate” was a seriously inappropriate thing to say, though I’m not sure if she backed down entirely from her original advice.

    I happen to agree with you that MC’s answer to the breast milk question was both poor advice and disappointingly anti-feminist — I don’t have to be on board with every column to appreciate her as a writer and a person — but quite honestly, I wonder why you decided to bring it up here. Your comment was off-topic and insulting to someone FJ clearly identified as a friend of the blog. That doesn’t seem like you.

  68. It’s quite possible every single person in an active anorexic’s life actively supports her illness.

    Or denies that she even has a problem. Or ever did. Or says that, well, she used to be fat (a whopping size 12), so it’s OK that she feels a horrific amount of guilt if she doesn’t exercise a minimum of 3 hours a day and eat only about 1500 calories at most, despite 3 hours of hard cardio a day.

    Recovered? *snort* If by ‘recovered’ you mean she isn’t trying to subsist on 300 calories a day (with the running) anymore, sure, but other than that, no, she’s not recovered. She thinks that anyone who weighs more than she does (actually, anyone who weighs more than she did 10 lbs ago) is fat, ugly, disgusting, lazy, horrible, and evil. That includes, say, her mother and me, as well as 95% of the population.

    No, I’m not talking about myself, but I am talking about someone proximally close to me, about whom I can’t ever say anything because then I’m being mean to her. She’s in the process of ruining her health (already not perfect from the anorexia) and I can’t say or do anything. So I’m frustrated.

    Sorry for anonymity, but I needed to vent briefly.

  69. Harriet, yes, it is more than thinness but that doesn’t mean you (or anyone else) can magically see it in strangers. The only people who knew about me, for instance, when I was a young teenager and surrounded by people almost all the time, was my mother. Dad and brother were clueless, and so were all my teachers, friends, and visiting relatives.

    You say: “As far as recognizing the look of someone with anorexia, you’re right; it’s more than thinness. It’s also a look of deep despair and hopelessness in their eyes. You can cover it up sometimes but it’s under there.”

    Firstly, not everyone with anorexia appears troubled. I was on a HIGH most of the time I was starving myself. Looking up manic states, I’m pretty sure I was in a kind of mania back then. If you’d looked in my eyes, you would have seen a very excitable person.

    Secondly, I don’t believe for one moment that you (general usage) can look in someone’s eyes and know their troubles, whether they’re mentally ill, suffering through the loss of a loved one, or otherwise troubled. That’s a rather romantic notion, which I think is self-deluding in this case, particularly because one of the main behavioural traits with EDs is attempting to hide them, which many anorexics do extremely well.

    I’m not trying to be hard on you but, as a former anorexic and someone who still suffers with mental illness today, I am rather scornful of the idea that strangers can look in my eyes and “just know”. Because they can’t, and don’t. Even people I know well are often shocked when I “out” myself to them, despite our frequent eye contact.

    And, as Sweet Machine says, even if you were somehow able to acquire such a talent, its still not our place to comment on such a topic to strangers, anyone else who doesn’t explicitly invite our opinion, or is otherwise in our care (as a professional or family member to a minor).

  70. I agree about ‘just knowing.’ Even when there is clear behavior I can evaluate (which there isn’t with a stranger), I still *ask.* And if I’m still concerned about the specific behavior and worried for someone I care about after asking, I’m truthful about that – but I don’t feel comfortable projecting (because I might be) or presuming (because I can easily be wrong).

    Anonymous at 4:42 – I’m not sure I get exactly where you’re coming from, but if you want to vent or brainstorm, feel free to email me (theriomorph at theriomorph dot com) – I probably don’t have any ideas you haven’t tried, but I’d be happy to listen & offer my perspective if it’s helpful.

  71. Um, I never implied that I have magical powers and always know about everyone with anorexia. I think you’ve all taken my words a bit out of context. And I’m not advocating rushing up to every stranger and blurting out, “Hey, are you mentally ill?”

    Give me a little credit here, please. I think I will recuse myself from further comment, as this has become upsetting.

  72. Miss Conduct, who is thin, may nevertheless be the only advice columnist writing today who truly gets far issues

    I wish this sentence hadn’t caught my eye. I’m already on fj’s shit list. So, maybe I just don’t understand.

    Why doesn’t this sentence imply that what Miss Conduct looks like would make it easier or harder for her to understand body issues?

    Should “who is thin” here be replaced with “who does not feel she has body acceptance issues of her own?”

  73. atiton, I’m not sure why you think you’re on any shit lists around here, but if you have never gotten a ban warning you can be pretty sure we’re all over it. To address your question, I don’t think it’s unreasonable to point out that Miss Conduct is a good ally to fat people even though she may not have the lived experience of a fat person. No one’s saying anything about her psychology.

  74. just want to chime in here with the “chronic diarrhea” issue–as someone who did lose a substantial amount of weight due to what turned out to be irritable bowel syndrome, it might not be as unlikely as you think. heh.

    I did get a lot of “you are so thin! …are you okay?” comments, often phrased in a way that was both a compliment and a concern, which was chilling. are you complimenting me on my thinness, or concerned about my health? and if it’s both, what does that say about our perception of thinness?

    ironically, I had far fewer body image issues before everyone started complimenting me on my newly thin physique. I started to think “if everyone’s giving me compliments now, what did they think of me before?” which made me not want to gain the weight back, even though gaining weight was a sign that I could eat normally again.

    so I agree that it’s always invasive to bring up someone’s body in regards to their health. remember that even if you think you’re complimenting someone, you aren’t necessarily making them feel better about themselves, and might actually be making things worse.

  75. philosopherkrista, if the person really has anorexia they have no idea how they really look. In those cases I would say be as honest as possible. A friend of mine who had anorexia asked me how I thought she looked. I told her truthfully, “You look really sick.” She was sick and she needed to know that. She was hospitalized and eventually regained her health. Recently we went to listen to a speaker whose daughter died of anorexia. It is a life or death situation and if you have a friend with the disease you do them no favors by sugar coating it.

  76. just want to chime in here with the “chronic diarrhea” issue–as someone who did lose a substantial amount of weight due to what turned out to be irritable bowel syndrome, it might not be as unlikely as you think.

    Oh, I know it’s possible — talk to SM about that one (and people’s reactions)! Mostly I wrote down “maybe she has a parasite” and then I was like “pffft.” But it’s absolutely a possibility that she has an intestinal disorder.

  77. Why doesn’t this sentence imply that what Miss Conduct looks like would make it easier or harder for her to understand body issues?

    I think that thin people may well be less likely to understand FAT issues (not “body issues” in general), having not, you know, necessarily had the experience of living in this society as a fat person.

    fillyjonk’s point seemed clear to me: Miss Conduct has given a lot of thought to a lot of issues, including ones she has not necessarily personally experienced, like being fat.

  78. By “thin people” I mean “the set of all thin people” not any individual person who is thin. My apologies for the syntactic ambiguity.

  79. @Jess – not everyone with anorexia has body image distortion in which they don’t know that they’re underweight. Some anorexics truly believe they are fat. Some anorexics have no body image distortion at all.

    In my experience, most of the anorexics I have talked to have a sort-of body image distortion where they logically KNOW they are underweight and too thin, but are unable too see it in the mirror, or believe that although they are underweight, they aren’t thin enough.

  80. I was in a similar situation once, where a new neighbor’s child looked very thin to me. She hung out at another neighbors a lot, so what I did was ask that neighbor if she knew anything; and she said that the girl ate like a horse at her house, so I figured out that she’s just naturally thin. They’ve been here about three years now and the girl seems to grow normally and is clearly hitting puberty; but is still very thin while being healthy.

    I think if I hadn’t had the other neighbor to ask, I’d probably been a lot more worried about her.

  81. It’s my impression that naturally thin people have a decent chance of noticing that society is insane on the subject of fatness. They keep getting complimented on something that they know is just a matter of luck, and that can function as a clue.

  82. Thanks for this post. This is a tough issue. I’ve been extremely thin all my life, but it’s just my metabolism. I hated my body in my youth because of all the people who were “concerned about my health.” My gym teacher pestered me, the other girls insulted me, adults asked me whether I was eating. I felt like no one would just leave me alone and accept my body for what it was. No one ever said anything positive about my body. I used to try to force myself to eat massive quantities of food and would end up with stomachaches.

    Just be careful how you approach someone with a “concern,” because all those concerned people sure didn’t help me any.

  83. Isabel: “…I do think there are many situations where a teacher of a child or even a young adult does have the right to express concern over a student’s mental health either to the student, to the parent, or to someone in the school who is more qualified in matters of mental health.”

    Well, teachers typically are mandated reporters so if any kind of abuse or neglect of a minor is suspected, they’re legally obligated to report it to child welfare authorities.

  84. Caro said, does anyone else here want to add anything about how they’ve dealt with family members? Especially when the concern is always couched as “I’m worried about your health.”

    My best answer is always “My doctor and I agree I am healthy.”

    After that, I get my rude on and start explaining the HIPAA rules to them in detail. It helps that I work in healthcare administration and have these things memorized.

  85. Yesterday, I had to come in to work a couple hours late (approved by my sup) due to an unreschedulable doctor’s appointment. Normally hubby drops me off and goes to park the car, but he wasn’t there. So I had to hurry up that long steep hill to the workplace.
    And in doing so, out of breath and trembling and with a lowered sense of balance, I ended up falling into a pile of rocks face-first.

    Fortunately my coat hood was up, so I sustained some bruising, but no serious scrapes or cuts.

    But later that day my sup (who is a dear, sweet woman, whom I absolutely love, who has been an excellent person to me otherwise) came up to me and “joked”: “Are you sure Matt didn’t hit you or anything?” and laughed and walked away.

    So, look. I grew up in an abusive family. I was not the one subject to physical abuse, but it was a dark and heavy cloud that hung over my head every single day. Any time I got a bruise Mom made me wear long pants or a sweater to cover it up, so no one would think she beat me. Because that was HER daily reality. And look – I was a CHILD, even one with a chronic pain condition, I was into everything and of course I got bruised and scraped up all over the damn place! But the first thought was always how to cover it up so no one thought anything sinister…

    Having my boss come up to me and make that “joke” is just not funny. Having her come up and seriously ask – not funny either, not helpful. It just brings up painful memories and makes me feel like I am making excuses for an abuser — even though Matt is the furthest thing from abusive, and anyway, I FUCKING FELL.

    So, look – this is broadly applicable. It’s none of your fucking business. I think the fact that my workplace has at least one poster per square yard of wall about the local DV shelters and so forth, and the fact that I know my sup would be supportive if that WAS the case, is more than enough. But take it from an abuse victim raised by a cadre of abuse victims. When someone makes that kind of comment, you don’t break down and ask them for help. 99.99999999992% of the time, you IMMEDIATELY put up a wall and make sure to isolate yourself from this person, to put up a careful appearance of innocence in front of them. It has the potential to make things much, much, MUCH worse.

    The best way to help in these situations? Help strengthen institutional support. People in bad situations will take advantage of those support systems when they feel ready — but for as long as they’re having to defend themselves against people they know personally (including acquaintances) they aren’t going to feel ready, because they’re going to be further mired in that defensive wall-building, protecting themselves from having someone like you make any more of those kinds of comments at them.

    Dos centavos, mis amig@s.

  86. I always feel unnecessarily harsh when I make this kind of point. But I do feel those sorts of attitudes are not just unhelpful, but actively harmful. You aren’t making her situation better — you’re helping refine her social defense skills so that she can hide it from you (and those like you) even better. So please, think more than just twice.

  87. I also say this as, ahem, a formerly stick-skinny person (see also) who was constantly accused of anorexia. And I use the word “accused” because that was the tone of it, most of the time. So much that even the softer, more “concerned” prompts were colored by the more self-righteous, gotcha-type, just-a-way-to-put-a-nonconventional-female-body-down prompts.

    Anyway, my husband is also (and always has been) stick-skinnier than I was, though he doesn’t get those sorts of accusations quite so much. More than that, he gets jokes about who’d win in a fight. Twelve of one, half a dozen of the other, I guess.

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